Clinical Topics   /   Oncology

VA Care Not Timely in Early Lung Cancer; But Did It Matter?

by Annette Boyle
June 1, 2018

SAN DIEGO — Multiple organizations have recommended timely treatment for patients with lung cancer. What exactly that means varies, with the RAND corporation recommending not more than eight weeks from first abnormal chest imaging to diagnosis and not more than six weeks from diagnosis to any planned treatment. The American College of Chest Physicians, meanwhile, recommends that “the delivery of care be timely and efficient” but “balanced with the need to attend to other dimensions of healthcare quality.”

A new study, however, raises a pertinent question: Does timeliness actually improve progression free or overall survival?

Not according to the research released in conjunction with the 2018 American Society of Clinical Oncology Annual Meeting in Chicago. A team led by Duc Ha, MD, of the VA San Diego Healthcare System and the University of California San Diego Medical Center, found that treatment timeliness had no impact on survival in patients with stage I-IIIa lung cancer.1

The researchers conducted a retrospective review of 177 patients with lung cancer who sought treatment at the VA San Diego Healthcare System between October 2010 and April 2017. All patients had stage I-IIIa malignancies and were eligible for treatment with curative intent. The team analyzed variables associated with time to treatment and survival in lung cancer including age, sex, race, tobacco use/exposure, performance status, comorbidities, tumor size, clinical stage, histology and treatment type. They used the simplified comorbidity score to weigh the impact of comorbidities on survival.

In this cohort, the study found that the median time to treatment was 35 days and that between 33% and 77% of patients received timely treatment. Patients had a median overall survival of 42 months.

Longer time to treatment was associated with other cancer history, significant comorbidities, smaller tumor size, earlier disease stage and definitive radiation treatment. Univariate analysis indicated that tobacco exposure, simplified comorbidity score, diffusion capacity of the lung, stage and treatment type were associated with overall survival. On multivariate analysis, only diffusion capacity of the lung and treatment type remained significantly correlated to overall survival. Surgical resection with chemoradiation reduced mortality risk 69% and definitive radiation with chemoradiation reduced the risk of death 62%.

Time to treatment and treatment within guidelines for timeliness were not associated with improved overall survival in either analysis for patients at any stage. For patients with stage 1 lung cancer, time to treatment and receipt of treatment within timeliness guidelines was also not associated with disease-free survival.

These results support the findings of multiple other studies that determined delaying treatment in lung cancer does not impair outcomes and might improve survival when used to permit patients to quit smoking or to identify biomarkers that can guide treatment.2


1Ha D, Ries AL, Fuster MM. Time to Treatment and survival in veterans with stage I-IIIA lung cancer eligible for curative intent therapy. J Clin Oncol 36, 2018; (suppl; abstr e20519).

2Bullard JT, Eberth JM, Arrington AK, Adams SA, Cheng X, Salloum RG. Timeliness of Treatment Initiation and Associated Survival Following Diagnosis of Non–Small-Cell Lung Cancer in South Carolina. Southern Medical Journal. 2017;110(2):107-113.

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